=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417956582
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KENNETH O. KARP MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2005
-----------------------------------------------------
Last Update Date | 05/11/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1951 SW 172ND AVE SUITE 304
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33029-5593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-437-4316
-----------------------------------------------------
Fax | 954-437-4352
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1951 SW 172ND AVE 304
-----------------------------------------------------
City | MIRAMAR
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33029-5593
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-437-4316
-----------------------------------------------------
Fax | 954-437-4352
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207W00000X
-----------------------------------------------------
Taxonomy Name | Ophthalmology Physician
-----------------------------------------------------
License Number | ME78010
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------